Incidence and Significance of Microbiological Results and Antimicrobial Prophylaxis in Patients Undergoing Total Pancreatectomy with Autologous Islet Cell Transplant

Abstract

Introduction: The impact of microbiological findings in the preservation, cannulation solutions, and final islet cell product is debatable amongst providers taking care of patient undergoing total pancreatectomy with autologous islet cell-transplantation (TPAIT). It is further challenged by the lack of guidelines on the type and duration of antimicrobial prophylaxis needed. We aimed to correlate post-op infections to theses cultures and the efficacy of antimicrobial prophylaxis. Methods: Twenty-two patient’s (February 1, 2018 to August 31, 2021) microbiological data from the preservation, cannulation, and final islet cell cultures and their 60 days post-transplant infections were retrospectively analyzed. Results: Microbial cultures were positive in 5 (22.7%) patient’s preservation solution, 4 (18.2%) cannulation solution, and 6 (27.3%) final products (Table 1). Most common antimicrobial prophylaxis regimens were piperacillin/tazobactam (pip/tazo), vancomycin, and micafungin (n=9). The average duration was seven days (range: 2-10). Six patients were discharged on amoxicillin/clavulanic acid. Three patients (14%) had infections: 2 (9%) had Clostridium difficile (22 and 37 days after surgery), 1 (5%) had Candida albicans growing from the abdominal collection (59 days) with no growth in any of the isolation cultures, and 1 (5%) had Burkholderia cepacia in urine (44 days). Conclusion: Isolation procedure and final product cultures were not associated with any infections. Broad spectrum antimicrobial use intra- and post-operatively and extended oral antimicrobial therapy may have minimized the number of infectious outcomes. Consideration is warranted regarding the use of antimicrobial prophylaxis and duration as some of these agents pose a risk for C. difficile.Tabled 1EP02F-020Final Islet Cell CulturePreservation SolutionCannulation Solution1Yeast like organisms in anaerobic cultureNegativeYeast like organisms in anaerobic culture2Initially resulted as gram positive cocci with final identification as Granulicatella adiacensNegativeInitially resulted with gram negative rods in both aerobic and anaerobic cultures. Final report of Klebsiella pneumonia in the aerobic culture and Enterobacter species in anaerobic culture.3Streptococcus massiliensis from aerobic cultureNegativeNegative4Yeast like organisms in anaerobic cultureGram negative rods in aerobic and anaerobic culturesGram negative rods in aerobic and anaerobic cultures5NegativeGram positive rods in anaerobic cultureNegative6Gram positive cocci in anaerobic cultureGram negative rods in aerobic cultureNegative7Gram positive cocci in aerobic and anaerobic culturesGram negative rods in aerobic and anaerobic culturesGram negative rods in aerobic and anaerobic cultures8NegativeGram positive cocci in anaerobic cultureNegative Open table in a new tab